36 The patience of Job

In Africa, life moves at a slower pace, towards an ironically shorter end. Planned change, if it happens at all, happens in African time, which begins tomorrow, and then takes a break for a while. It is almost a sign of weakness to pitch up to a meeting on time in Africa, and it is certainly a sign of naivety, (unless there are free sandwiches), as no one else will be there.

Even African leaders are calling for Africans to set their body clocks to today:

http://www.globaltimes.cn/content/788640.shtml

In rural Tanzania, then, those planning long-term, sustainable change need not just all the other positive attributes of change agents, but also the patience of Job.

(The ‘Patience of Job’, as you probably know, refers to the proverbial patience of a Biblical figure who lived, it seems, soon after Abraham.

He lost everything he had, including all his wealth, camels, sheep, donkeys, and friends – and even his children, who all died. Then, when he had patiently proved his submission to God, he was rewarded with twice as much wealth, and twice as many camels, sheep, donkeys, and friends. And also ten replacement children – these were the days before University tuition fees.)

Anyway, even Job would have raised an intolerant eyebrow at the vicissitudes of the women of rural Africa. Not dying in childbirth surely should have been an urgent need for endless generations. African women have been far too patient.

Even if Job were getting restless for action, however, it does not imply that the alternative way ahead should therefore be given over entirely to impatience.

I say this despite being something of an expert on impatience. Surgeons are naturally impatient, but I have taken it to new levels, and indeed have invented several forms of impatience previously unknown to mankind. There cannot be many people, for instance, who never listen to the BBC news on the radio, because it is unbearable to waste 6 beeps of their life waiting for it to start.

(My wife, by contrast, is very, very patient. Very patient. When we first met, she used to slow the car as she approached green traffic lights, so as to be ready in case they turned red. Commendably safe, I am sure, but only love, deep respect, and lack of dual controls and a cricket bat stopped me from taking command. Safety is not everything. I eventually brought her round by making her morning cup of tea with cold bathwater in case I scalded myself.)

Anyway, here is the paradox: When things go naturally slowly, impatience can be a useful and necessary driver to kick-start some action: getting a caesarean done quickly, for instance, in a culture where people traditionally meander to the theatre when they are ready. However, impatience is a blunt instrument. Getting things to happen quickly, and getting angry when they don’t, is likely to produce a quick-fix solution – or drive you to an early grave without yielding a benefit.

(The early-grave danger is a particular worry, given the paroxysmal wrath induced in me by automated phone-answering systems:

“Hi! My name is Emma. Welcome to the Public Toilet Opening Times Enquiry Service.

With my initially soothing but eventually apoplexy-inducing voice, I am going to guide you through the options, at the same time as liberally sprinkling my patronising pronouncement with infuriatingly facile irrelevancies.

Press 1 if you would like to know the nearest public toilet to your current location. This service can only be accessed by honorary life members, or by adding the access code which you will find on the door of any public toilet.

Press 2 if you would like to know how much time and money you have wasted on our automated phone system, and others like it, over the past year.

Press 3 if you would like to start going round a seemingly endless set of options which eventually by tomorrow lunchtime leads you back to this one.

I’m sorry. I did not understand that.

Please try again, but without hitting your phone needlessly hard, or throwing it against a wall and stamping on the remains.

OK. Using a six-digit number system, please say or enter on your keypad the date of birth of your favourite estate-agent’s best friend.

You seem to be having trouble.

If you have forgotten your security data, you can refresh it now, by logging into

http://www.pleaserefreshmydataeventhoughtogetonthesiteIneedmypasswordwhichI’vealsoforgotten@deathbyinternet.com, and enter the length of the second molar of your first pet.

Well done. You are nearly there.

Finally, whilst you are on-line, we need to know that you are not a robot.

Here is a 1x1cm picture of smudged Turkish graffiti on a toilet wall in Istanbul, in a photo taken from the International Space Station. What are the second and fourth letters of the signature?

Press 4 if you have already been incontinent.”

It’s a tricky thing, then, impatience. It is not about efficiency, or getting a job done as best as possible in the time available. It’s not even about making sure that the final result is the one you want. Impatient driving for instance, gets you there no faster, risks not getting you there at all, and annoys everyone, include yourself, in the process.

Impatience, then, is not about passion for excellence. It is simply about being determined that the next five seconds go to plan. Then the next five seconds. And so on. In surgery, that it is almost always good, but in the rest of life, impatience is a hindrance to the smooth flowing of a calm and productive existence.

And so, finally, to the point. (Thank you for your patience.) I went out to Tanzania nearly two years ago, to the remote villages around Berega:

I came back pumped up with impatient determination to help Berega tackle the desperate tragedy of death in childbirth. Out of this was born EMBRACE-Tushikamane.

That project plans to begin by building a platform of women’s groups in the remote rural hamlets, as we now know this to be an important prelude to success.

A year ago, we had already mustered: the money to begin; the partners to help us succeed; the experts in the methodology to advise us; the charitable NGO to house our efforts; the freshly-mapped road plans of the territory; the support of the community and the hospital; the potential recruits as local project leads; three people who regularly read this blog; and even a highly talented PhD researcher to analyse what will happen.

However, much as these achievements might have been immediately gratifying, they are not enough. On kicking off the project, we would have had fulfilling 5 seconds, with many more of them to follow, but, finally, we would have joined the vast list of well-intentioned failures. The reason is this: firstly, we need a system whereby the women of the villages not just keep up the impetus, but spread it to surrounding villages, until it becomes the norm for rural Tanzanian women collectively to take action to tackle the roots of the problems that kill them.

Secondly, we also need successful examples of where the women’s group’s energy and prioritisation has led to sustainable development: better health, better nutrition, better childbirth arrangements, cleaner water, better antenatal care, better family planning, and so on. 

Thirdly, we need individual champions to spread the lessons.

However, for all this to happen, and happen well, our central need is to embed the whole process in Tanzanian people, Tanzanian systems, and Tanzanian ways of doing things. From the training of the project leads and community leaders, through to the coordination of responses, all of this must be integrated into a Tanzanian-led, Tanzania-based system.

To move towards this goal, we have needed the patience of Job – and so have you, when months drift by without anything seeming to change. However, we are getting there. We have identified Ifakara as the epicentre of these developments, and we now have buy-in from two major players, each with a great international reputation for making a difference:

http://www.ihi.or.tz/

http://www.healthtrainingifakara.org/

I hope by the next blog to be able to report that we have a Tanzanian project manager working with these Institutions, and a date for the start: of the collaboration, of local staff selection, and of training.

After far too many generations, that will be Job well done.

35. Every Dog Has His Day (And women get 8th March)

In England, there is a saying: ‘Every dog has his day’. It means that, if you are a dog, then sooner or later your time of favour will come.

For at least one of your 4,000 days on the planet, you will not be made to sit or do tricks; you will be permitted to eat that deliciously decaying detritus you found under a bush; and humans will understand the honour you are bestowing when you mark your territory on their trouser leg.

However, I have to say that for me, the jury is still out on the value of this saying as a piece of proverbial wisdom to pass down the generations:

“Don’t worry, son, every dog has his day!”

“Oh thanks Dad! Does that mean that soon I will stop being bullied, and instead will start being appreciated by my teachers, will then have my talents nurtured, and eventually will conquer all injustice and settle down to a life of peace and plenty?”

“Er, no, son. It means that today, on a special deal which I can offer for one day only, I won’t scold you if you chase our cat.”

(It is no surprise to me, by the way, that this adage might be of little worth, given that it was popularised by Shakespeare in his play, Hamlet. We are talking about a play in which the hero is named after a cigar or small town; when he’s not talking to himself, he talks to ghosts and skulls; and yet he feigns madness by speaking Mediaeval English. Then everyone dies. This is not the output of a rational mind.)

It is not for its edification, then, that I began thinking about this proverb on International Women’s Day last month, but for its subliminal implications. Every dog has its day? All the women on earth get one day on 8th March, but dogs get one each?

But here is an extension of these musings on canine quotas. Being 'a bit of a dog’ is something of a backhanded compliment, so I'd be quite content with the comparison, and would get on and have my day. However, if there were a parallel axiom for the female of the species, it would not roll off the tongue quite so well. “Every bitch has her day” doesn’t really work as a pick-me-up for the downtrodden. Dog = fine. Bitch= insult. Where does this all come from?

It seems that right from Saxon times and before, the males of commonly encountered animals had names to be aspired to, macho and manly: stallion, bull, cock, buck, stag, ram, stud, etc. Much of this Teutonic nomenclature legitimately derives from the tendency of male mammals, in due season, when they stop fighting, feasting and farting, to exhibit something of an appetite for cocking, bucking, stagging, studding, ramming, and the like. Fair play. We are who we are. Those Saxons called it like they saw it.

By this argument, however, the female Saxon species-names should reflect, by contrast, some feminine qualities. A bull’s mate might have been a ‘Feeder’, or ‘Carer’. A carthorse’s companion could perhaps have been a ‘Toiler’. A fox or dog’s life-partner maybe a ‘Rearer’:

Instead of which, we have ‘cow’, ‘nag’, 'vixen', and ‘bitch’. To which we could add mare, sow, nanny, and hind.

I have a theory as to how this derogatory naming-system came about. Given that Saxon tribes did not speak the same language as Romans, Vikings, Gauls, and others around them, it follows that there must have been a time when they were inventing the words for the world they lived in. This presumably happened around the campfire at night-time, when the menfolk got back from procuring, protecting, plundering, and perhaps a touch of extempore procreating. 

The women would then of course be tasked with preparing the cerf-en-croute, and would only get a fleeting chance for a chat. Even the hen-pecked warrior would hesitate to be late for the nocturnal naming-fest, no matter how much he valued his spouse’s view.

So you might imagine a conversation like this:

Woman: “O Hunter-man!”

(This is before they had names even for themselves)

Man: “Yes O Broth-But-Sometimes-Stew-Woman?”

Woman: “Tonight, men at fire are naming our horned-milk-beast!”
Man: “Yes. And me got good idea: Me say call it: ‘Bob’ …”
Woman: “Hmm… Me no like ‘Bob’. Not very female. No. You must call it ‘Succa-Succa-Life-Milk’.”

Man: “If me call it ‘Succa-Succa-Life-Milk’, Hunter-War-men hurt me bad …”

Woman: “If you love me, you call it ‘Succa-Succa-Life-Milk’ …”

(later, after naming fest):

Woman: “O Hunter Man! Why you got only one eye?”

Man: “They’re going with ‘cow’ …”

As then, now. A barely noticed inequity and imbalance, and yet one which defines and destabilises the very basis of our lives: Men, (well, actually, males, and even then not all of them), when given the authority, the power, and a free rein, tend to have a more violent and openly confrontational world view. The result has been a world in which war is more important than water, and cruelty is a stronger currency than caring.

(By the way, if you are a woman reading this, don’t get smug. If women alone had the authority, the power, and a free rein, the world would still be unbalanced and unstable:

“My Lady!!! Even now the enemy are at the gates of the Tower of London!”

“Then haste! Summon my Personal Guard!”

“The Tofu-Eaters are already in position, Ma’am!”

“Have they their needles?”

“Ready at your command, Ma’am.”

“Then let the Tapestry begin!!”

This is nonsensical stereotyping, of course, but it made me laugh, so I couldn’t resist. I just want to say that we share the same differences. What we need, but don’t have, is balance.)

But to the serious point: Balance. Yin and yang. Competition and cooperation. Determination and concession. The view of those who are running the country; and the view of those who are running the home. The perspective of those travelling miles for work; and that of those travelling miles for water. The old customs; but the new understanding – of society, of family, of health, of disease, and of why so many mothers die in childbirth.

Look, it’s far, far too much of an over-simplification to suggest that war and violence are a man thing. But you can’t help feeling that many of the most unspeakable excesses that currently plague our news-streams would not be occurring in a world where women had a full say.

What is certainly true is this: in rural Malawian villages where women have found a voice – with the blessing, participation and encouragement of the men – truly wonderful things are happening. The desperate toll of death in childbirth is finally reducing. Please watch again:

http://vimeo.com/12427420

Florida Banda and Mikey Rosato, two of the key players in this transformation, are fully signed up to the EMBRACE-Tushikamane project to spread the development of women’s groups into rural Tanzania.

Even as I write, I am waiting for finalisation of the inaugural meeting of Florida with EMBRACE’s Tanzanian partners. The conference will celebrate the success of community participation and women’s groups in reducing deaths of mums and babies in the villages of Malawi. Its main focus, however, will be on how to spread the lessons to other countries – especially neighbouring Tanzania, which shares so much in culture and deprivation.

I will have to play my part in catalysing where I can, but my main role must of course eventually be to make myself entirely dispensable. I’m working on it.

Meanwhile, I am not a woman, I’m not from a village, and I’m not even African, but I do hope I get to see the tragedy of death in childbirth beginning to be a rarity in rural Tanzania.

Maybe I will.

Every dog has his day.

34. New Year's Resolution

January 2015

Oh, dear. So much for my New Year’s Resolution.

I had resolved, for the sake of posterity as well as for you three readers of this blog, to make an entry every couple of weeks. Sadly, more than a month later, I am facing up to the possibility of losing even your hard-won loyalty. (Although you seem to be reading this…)

I have no excuses. I am retired after all, which means that I can resolve to do what I like, as long as it is legal, wise, and doesn’t start before 9.30 am.

Yes, 9.30. For six decades, I have submitted to the tyranny of sunrise, and to its autocratic preoccupation with startling us deep-sleepers from our slumber. What’s more, Sunrise’s Little Helpers draw perverse pleasure from following up on their Mistress’s whim. I have been elbowed in the ribs. I have had the covers yanked from the jelly that will later be myself. I have been taunted from across the room by the smug optimism of the radio-alarm. I have begged for just five more minutes to finish a tantalising dream in which I invent an amazing ... (well of course I can't tell you what it was, because I was woken before the end.)  In every case, until I retired, Sunrise won.

Now, however, in a Snoozers’ Spring that brings hope around the world to those oppressed by Alectrona’s despotic grip on the eiderdown, I have broken the yoke.

(Alectrona, by the way, was the Greek goddess of getting up in the morning:

Presumably she was in the loo when Zeus was giving out jobs: ‘god of the oceans’, ‘king of the planets’, ‘god without portfolio’, and the like.

“Sorry I’m late, Zeus. Whatcha got?”

“Oh Alectrona! I forgot about you! I was going to give you ‘goddess of silent transport’, but it’s gone. Didn’t even hear it go.”

“Never mind, Zeus. I’m easy. What’s left in the bag?”

“Umm… well actually only … ‘goddess of getting up in the morning’, ‘goddess of toothache’, and ‘goddess of flat-packed furniture’ …”

“You’ve got to be kidding!!” etc)

Anyway, you get the point that for some of us on the planet, getting up needs to be an altogether more measured process than being unceremoniously decanted into reality, an hour before your metabolism.

Being aware of my surroundings from 9.30 onwards, however, still gives me plenty of time to write a blog.

Assuming that I don’t hit Writer’s Bloc …

February 2015

Ah yes. The blog. Right, here goes:

A few nights ago I spoke about EMBRACE-Tushikamane to a group of Coventry women belonging to a society called ‘The Soroptimists’. It sounded like it should be a society of post-Nostradamus Alchemists seeking The Lost Scroll of Soropto, so, before I did the talk, I checked out whom these people might be. In fact, the word means ‘Sisters of excellence’ or ‘The best for Sisters’. Their web site describes their work:

‘Soroptimist International is a global volunteer movement working together to transform the lives of women and girls. Our network of around 80,000 club members in 130 countries and territories works at local, national and international level to educate, empower, and enable opportunities for women and girls’.

So. I was coming to tell the people who already know, that the solution to the awful inadequacies of rural Africa is empowerment of women and girls. Hmm. It seems that there really is nothing new under the sun.

Soroptimists began in 1921 in California, ten years after women got the vote in that State, and one year after women’s suffrage was finally won for all women in the USA, after a long and bitter battle.

In those days, universal suffrage was felt to be a matter of human rights, but rather impractical. It was going to take some considerable effort and expense to make it happen – like building a house or a school or a road. It transpired, over the next three generations, that this road, far from being impractical, was actually the only road leading from war and intolerance and privation and poverty; to safety, freedom, abundance and justice.  Giving a voice to the un-empowered, the disenfranchised and the oppressed, turned out to be a rich investment for society.

Such richness is not just societal: a country’s actual wealth and life expectancy are directly proportional to the rate of female emancipation. I have mused before in this blog, as to why this counter-intuitive ingredient of civilisation’s recipe should be so vital. The yang of assertion and seeming-strength, has traditionally seemed more worthy of pursuit than the yin of vulnerability and seeming-weakness. But of course, both yin and yang are needed in any sustainable solution. 

Some Chinese already understood this balance nearly three millennia ago. In many rural areas of sub-Saharan African countries, however, the balance of equal gender-opportunity is conspicuous by its absence.  In most of these countries, for instance, less than half the girls even finish primary school. Poverty, or domestic duties, or conflict, or betrothal, or even predation, separate girls from their potential before even the innocence of their girlhood is over. In the process, the country ironically loses the solutions to the precise problems which tie it to under-development.

Let me give a real example: Jenipher Namutosi. Jenipher lives in a remote village in Uganda, where for three decades she has fulfilled the traditional role demanded of her. Recently, she had her fifth child, and, as often happens with women after their fourth pregnancy, she began to bleed after delivery. This is the commonest cause of maternal death in the world, and one such death happens about every 10 minutes, somewhere on the planet. Jenipher was saved by the recent introduction of motor-bike ambulances by a Welsh charity. (See the wonderful video on: http://www.itv.com/news/wales/2014-10-07/catch-up-wheels-of-life-from-the-valleys-to-uganda/)

Stop and ask yourself, however, how it was that the ambulance, in a country riddled with corruption and inefficiency, was actually available, maintained, fuelled, and ready – and how the birth attendant knew when to call for help and what to do, and how the driver was able to deal with what he found. The answer of course is that community development in rural Africa simply cannot be unidimensional. You cannot air-drop solutions, then fly off again. Progress has to occur within a matrix of self-determination and community participation – and women’s voices are a vital component. Or as the Soroptimists so neatly put it: ‘Working together to transform lives’…

It goes without saying that of course by including women in the dialogue, a new perspective will take shape. For instance, it will cease to be lost on the community decision-makers that when you could only have afforded to feed, keep healthy and educate two children, then dying as you give birth to your fifth one might be counter-productive.

EMBRACE-Tushikamane is getting closer – in a painfully slow process – to working alongside a Tanzanian Health and Community Development Institute, to begin establishing women’s voices within hamlet and village-based self-determination. Its mission is to set up women’s groups in rural Morogoro, beginning in Tunguli.

We in the privileged world need to be there for the villages as they aspire to something better for the future of their communities. As hamlets in rural Tanzania begin to articulate their needs, we need to support organisations such as Mission Morogoro, (http://www.missionmorogoro.org.uk/), who are getting ready to support some of the ways in which the community will move into the twenty-first century.

A shameful loss of mothers and their children continues in rural Africa. 
We must resolve to help.
And help to resolve.

A New Year’s Resolution?

33. Missing the point

This would be a typical conversation with one of my daughters, when she was coming in late as a teenager:

Me: “Do you know what the time is?”

Her: “….(wordless scorn plus weary sigh plus angry face) ….

  

Me: “Well I’ll tell you. It’s nearly one o’clock in the morning.”

Her: “….(scoffing sigh plus angry face plus sharp downblast of air via the nostrils) ….

Me: (in conciliatory tone) “We’ve been really worried…”

Her: “….(disbelieving guttural sound plus angry face plus sharp downblast of air via the nostrils plus anguished groan) ….

Me: “And you promised you’d be in by midnight …”

Her: “….(incredulous snort plus angry face plus sharp downblast of air via the nostrils plus muttering about not believing this) …. “

Me: (pleading) “We’ve been through all this …”

Her: (with withering, piercing, impatience at my imbecility) “What’s your point!!!!!!!!!”

It seemed that I was missing the point. It was unjust of me, so I was made to understand, to expect that she should leave her friends just when they all were having a good time. Why didn’t I just trust her?

Now, a decade or more later, it’s all worked out very well indeed, and, what’s more, this nocturnal training has left me well-briefed in the need to get to the point quickly. (A lesson made the harder to implement because of my irresistible tendency to make room for important asides.)

So what’s my point in bringing this up? It is this: that justice appears not to be an absolute, but seems instead to depend on where you are standing.

Take the land of the Maasai, for instance – which is what the Tanzanian Government is trying to do, in part at least. The Loliondo territory is within ‘Maasailand’ and has been coveted by the Ortelo Business Corporation, a safari company set up by a UAE official close to the Dubai royal family. They want to turn it into an exclusive opportunity to kill the things that make the place particularly special:

http://www.theguardian.com/world/2014/nov/16/tanzania-government-accused-serengeti-sale-maasai-lands

http://www.avaaz.org/en/save_the_maasai/

http://action.sumofus.org/a/serengeti-land-grab/

The Maasai are objecting, and they have a point: They are one of the original tribes of East Africa, and they have been in this land for the last two or three centuries. It happens, however, that their homeland borders on one of the world’s greatest game reserves – the Seregeti. Loliondo is 1500 sq km smack in the middle of the Maasai traditional lands – and right next-door to the National Park:

But from the Government’s point of view, is this indeed Maasai-owned territory? The obvious interpretation would be that of course it is theirs, based on the (admittedly colonially-unsound) reason that they have lived there for so long. It’s where their homes are. Their villages. Their scrub-land. Their water-holes. Their holy places. It’s where the bones of their ancestors bleach in the sun. It is where their tumble-down mud dwellings are, from which the men head out into the wild bush in order to graze their cattle.

Another point of view, however, and another version of the justice of the situation, is that the land is not theirs at all. It belongs to the family of Tanzania. The Government owns all the land. (But let’s not stray too far into politics, here.) (OK, just a bit, then. In 1967, six years after coming to power, socialist president Julius Nyerere signed the Arusha Declaration, whereby ‘Ujamaa’ or ‘Being a family’, became the dominant Tanzanian policy. Collective farms forcibly replaced previous settlements, and many resources, including land, were nationalised, leading to widespread corruption and sometimes desperate privation.

At the same time, however, health and education took a major leap forwards. Nyerere was a devout, honest and good-hearted man, and his dedication – to freedom, unity, and family –  lives on in many a hip-hop rap; a legacy he encouraged.  Ultimately, however, for the large majority of the population, poverty and dependency were the outcome. As well as, technically, lack of individual ownership of their traditional lands.)

So the government sees itself as having every right to use the land in whatever way it chooses, because the Maasai do not own it. Their point is that tourism would be good for the nation. And it has of course offered to compensate the Maasai with money, (£10/head).

However, money does not buy existence, and existence is what the Maasai would not have in any other setting. Where could they go with the cattle? Where could they go without cattle? It is like clearing 40,000 of us out of a leafy suburb in Surrey, leaving behind our homes and livelihoods, and re-settling us in a trailer park in those parts of the Severn Estuary not yet permanently under three foot of water. But of course, we would be compensated with £10 per person, so we would not go short of porridge for at least a fortnight.

The point that the Government seem to be missing is this: At just around the same time that the displaced Maasai became the centre of an almost irremediable sociological disaster, the world outcry would have reached such a pitch that no-one would dare hunt in the territory anyway. Is there no solution that involves leaving the Maasai where they are, and still taking the lucre of the Emir? Surely there is?

I deeply hope the Maasai will win, and I hope as well that you will have the satisfaction of having added your name to the many million who have already signed petitions.

But if they do stay where they are, don’t let me leave you with the impression that Maasai life is an endless whirl of fun. (“Let’s camp here for the night then, Miterienanka. I’ll light a fire, cos I noticed a lion behind that bush, eating some missionaries.” “OK Ntirkana.  I’ll get the cappuccinos on the go. Cocoa or cinnamon?”)

Even when in possession of their land, Maasai have a tough life. So many of their children die soon after birth that they do not even name them until they are three months old. Thereafter, more than one in ten still die before the age of five – malaria, diarrhoea and dehydration, accidents, pneumonia, meningitis, TB, etc. In the African bush, with no money, no transport, and no privilege, there is nowhere to hide.

(Note, by the way, that the child above seems well-grown: having cattle and milk means that protein-malnutrition is much less common among Maasai than amongst other local tribes. But it’s still a tough life.)

Of the girls that survive, they have to marry young, so as to keep the tribe supplied with the next generation. Because they might begin to child-bear too early, far too many of these girls do not even make it past the first delivery. (I saw one close call myself, recorded in an earlier blog. The frightened fourteen-year-old was fortunate enough not only to be close to a hospital when she developed her pre-eclampsia, but to be born of parents who understood that Nature does not always get it right. When her blood pressure became dangerous to life, I offered her a caesarean section. The girl's mother refused – we have to wait until the grandfather sells a cow. In the night, the girl began to fit, and if you are going to get full-blown eclampsia in Africa, then do it in hospital, when an obstetrician is visiting. We saved the young mother, and I put the dead baby girl in the arms of the grandmother, who received her gratefully, reverently, and with just a bit too much resignation.)

So here’s the rub: Whilst Government officials are pointlessly planning to betray the country’s people and denude the country’s resources, it leaves them little time to deal with the real issues, which are the dreadful and preventable levels of mortality.

Given that the maternal death rate in Loliondo is around 100 times that in London; they are more than missing the point.

32. Normal Distribution

Normal Distribution

Half the women attending antenatal care in rural Tanzania are, on average, under-weight. Interestingly, however, this percentage is exactly the same in UK antenatal clinics. Does this mean that poor nutrition is not an issue in African villages?

  

Facts never lie. But neither do they always stand up to close scrutiny. It should not surprise you, of course, that 50% of women will be ‘under-weight’, if by this you mean that they are under the average. By definition half of Tanzanian women will be below Tanzanian average, and half above. The same logic applies to the UK. The true fact is of course that by UK standards, far too many rural Tanzanian women are malnourished.

My point is that I could, if I chose, weave the words to support whichever tapestry of beliefs I subscribed to. Vital as facts might be, they are worse than useless without correct interpretation.

(By the way, just to reassure all those who struggle when dealing with numbers, please keep reading. This blog brushes past the prickly subject of stats, but in a diligently thorn-proof way. I am well aware that 100 out of every 15 people in the world have dyscalculia, and for those with painful kidney stones, it’s made worse by also having dyslexia.)

(OK. A serious aside this time: On a scale from Asperger’s to broad, creative thinking, far and away the majority of genius lies towards the end of the scale where numbers and the written word are seen in a different way. ‘The gift of dyslexia’ encompasses some of the most important lights in the history of humanity – da Vinci and Einstein, for instance.)

Anyway, the point is that most of us have a touch of dyscalculia when it comes to interpreting scientific advance. The packaging of the stats-message often matters considerably more than what you find if you can be bothered to take off the wrappings. Present the message well, and the whole world is listening. Because of this, for instance, Mother Earth now spends £20+bn /year on statins. In more than 95% of cases, these statins do no good whatsoever, and in some cases, they do harm. (Notice my clever packaging of the anti-statin message, and please don’t stop taking them if you need them. I was just making a point.)

But it is indeed a hugely important point: At this rate of headstrong and introspective spending, in the 30 years it takes Generation X to pass to the next axis, the world will have spent £600bn on statins – almost all of it ‘wasted’. That would pay for everyone on the planet, every single soul, to have, for instance, safe water and sanitation; or an iPad-mini; or a luxury overnight trip for two on the Manchester Ship canal from Thelwall Viaduct to Weaver Sluice.

How in heaven’s name do we prioritise our collective spending like this? The answer is that we are too ready believe what we are told. When an expensive drug or gadget comes along, we can be tantalised and seduced into believing that we cannot live without it. Or, when a cheap or even cost-neutral bit of sense tries to influence the way we live, we can be too eager to dismiss it as ‘unproven’. (It took 30 years, for instance, from the first evidence that smoking was bad for you, for the message to be routinely adopted by doctors. It took even more than 30 years in the case of the deleterious effects of too much sugar. And, on a personal note, it has taken even more years again for me to assimilate the data that Malbec may not completely wipe out the harm done to one's metabolism by sausages. And I’m still not 101% convinced …)

So here’s the rub: we need information, and we need it to be well-interpreted, in order to legitimise and optimise our use of resources.

We need it, yes, but we don’t often get it, and so our choices can be skewed.

This need for the naked truth is particularly the case when our enthusiasm to do the right thing blinds us to potential negative effects of our actions. Our experience of anecdotal benefit and our anticipation of success, might too easily get in the way of learning proper lessons about what we have been doing. In the last generation or two of Aid from the privileged to the under-privileged nations, these lessons have often had to be learnt more than once. As a result, for instance, every armchair philanthropist now knows that we have to teach people to fish rather than giving them their daily mackerel. (A philosophy yet to bear much fruit in some parts of the Sahara.) The disappearance of overseas aid and good will into black holes is still too common a phenomenon in Africa. The rocks of inefficiency and corruption can shipwreck good-hearted dreams, and the swirling currents of perverse incentives and political expediency can cause many a good scheme to founder.

I am building up to identifying a critical insight about the EMBRACE-Tushikamane project: We need to be careful that we are using the resources to best effect.

Part of the answer is evaluation of impact: Did we save lives? Without doing much harm? However, even such a seemingly simple parameter of measurement is a sophisticated business, needing careful thought. If, for instance, as a response to the problems identified by women’s groups, we implement an improved transport system, linked to training of birth attendants to know which women to send in, then many more women might arrive at the hospital gates …

  

… including those who previously would have died at home on the bloody floor of their hut, or under the grubby lantern of a despairing attendant. The project might therefore, at first, seem to be delivering more death in hospital – but less in the community. Indeed, there may be far less overall, without this being apparent. These are tough issues needing a professional response.

These thoughts on measurement are going to need thoughtful development if EMBRACE-Tushikamane is going to have a long-term sustainable shelf life. I am delighted to report then, that Ammalife has found the wherewithal to support a researcher - Helen Williams - on a three-year PhD, devoted to the EMBRACE-Tushikamane project!! She will be carefully observing, documenting and measuring what happens, and in particular will be looking at how we build bridges across all those organisations trying to help. Suddenly, we have a real live hope that the project will produce transferable lessons for saving lives throughout rural Tanzania.

Meanwhile, let me finish by arguing with myself a little. Let's face it, I am the only one authorised to write on the blog site, and there is therefore the danger of portraying just one view of the topic. Fortunately, in this case I disagree wholeheartedly with myself, if I am trying to say that scientific evaluation is only about stats and normal distributions.

Statistics are vital, but so is narrative and observation of what happens. Stats could tell you that your results fall way outside the normal distribution, and that something unusual is happening. But they will not tell you why, so you might not be able to replicate success nor to rectify what seems like failure. An analogy: your data tells you that none of your flat-packed IKEA furniture seems to stay up long after you reconstruct it.  Number-crunching reveals that not a single item in your new bedroom suite withstood the weight of (respectively), an ironically full cup of coffee; an inquisitive cat; and a weary, end-of-day backside. What these stats don’t explain to you is that hammers don’t work on screws. Observation of what is happening can be as important as measuring the degree to which it happened.

And here is a further complexity: There will be times in science when numbers will be not just inadequate, but utterly beyond inadequate to tell the story. When Copernicus inferred that the Earth revolved around the sun, he did not need to check a representative number of solar systems to ensure that his conclusion reached statistical significance. When Watson and Crick tracked down the structure of DNA, they did not have to repeat the task with other molecules to prove it was not a fluke. At the heart of science is observation, combined with understanding about what you are seeing. Statistics are just a means to that end.

Numbers are important. Vital. But we should use the right tool for the right purpose. Sometimes it is analysis of data, followed by wise inference. Sometimes it is insightful observation and description. Sometimes, even science is inadequate to encapsulate wisdom, and only poignancy can capture the moment. I remember many many times, too many to count, when I have had the privilege to save a woman's life and to deliver a baby into her desperate and exhausted arms, and neither numbers nor words would suffice in describing what just happened.

So let me finish with an example of charitable intervention in Africa which reconciles all of these quandaries, which observes, measures, understands, adjusts - and delivers where it matters.  In the last blog I mentioned Water Aid’s wonderful To Be A Girl campaign, to provide villages with water so that the girls can be freed to live more appropriate lives.

The campaign recently wrapped up, and if you don’t cry when you watch the video, you get your money back:

https://www.youtube.com/watch?v=Op4Lopax3EA&list=UU3JVuo2A_Am7XW5tkFZRi5A

In African development, things can grind to ignominious and poorly understood defeat, under a wrapping of dyscalculia. Or they can work wonderfully. Water Aid is one of the successes, and water distribution is the foundation of future possibility - along with education, food, transport, community health, and eradication of extreme poverty. These are the most basic of human needs, sadly lacking throughout much of Africa. EMBRACE-Tushikamane seeks, in one small part of the planet anyway, to turn under-development into normal distribution.